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November 2, 2018 Gerald Blackwell

Meeting Registration and Update Form

THIS FORM IS ONLY FOR NEW OR EXISTING CoDA GROUPS TO REGISTER OR UPDATE THEIR INFORMATION WITH US.

IF YOU WANT TO ATTEND A MEETING YOU DO NOT NEED TO REGISTER AND/OR COMPLETE THIS FORM.

Co-Dependents Anonymous Canada

Meeting Registration and Update Form

Step 1 of 3

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Check Registration Type*
- Register a New Meeting
- Update an Existing Meeting
Group Name*
Group Number (if updating)
Day*
Time*
Other Group Information
Meeting Type*
- Open
- Closed (Identifying as Co-Dependent)
- Men
- Women
- Step
- Topic
- Online
- Book Study
- Gay
- Lesbian
- LGBTQ
Other (Please specify)

NOTE: If this is an Online Meeting please provide the Meeting URL in this box.

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Meeting Location / Building Name*

NOTE: If this is an Online Meeting please indicate the meeting platform (ex. Zoom)
Language Spoken
Meeting Address
Street Address Address Line 2 City Province Postal Code

Note: If this is an Online Meeting please complete the "City" and "Province" only
Original Startup Date
MM slash DD slash YYYY
Approx. # attending

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Mail Contact Information
Name
First Last Initial
Address
Street Address Address Line 2 City Province Postal Code Country

For the purpose of sending a New Meeting Starter Package
Meeting Contact Person #1
- I am a contact
Check this box of you wish to be a phone or email contact.
Name
First Last Initial
Phone
Email
Meeting Contact Person #2
- I am a contact
Check this box of you wish to be a phone or email contact.
Name
First Last Initial
Phone
Email
End of Registration Form
Email
This field is for validation purposes and should be left unchanged.

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